Mitral Regurgitation

Question 1

what are the problems of leaflets causing mitral regurgitation ?4

Answer 1

• prolapse
• rheumatic
• myxomatous
• endocarditis - relatively common

Question 2

what is prolapse normally due to

Answer 2

usually due to chordal rupture. You can get congenital rupture

Question 3

what causes a floppy (myxomatous) valve?

Answer 3

probably degenerative. You get a thickened, billowing mitral valve - barlow’s valve

Question 4

what are the other causes of MR?

Answer 4

chordae rupture

• papillary muscle rupture
• annular dilatation

Question 5

what can cause papillary muscle rupture?

Answer 5

ischaemia

Question 6

papillary muscle rupture can cause ________

Answer 6

severe pulmonary oedema

Question 7

most patients with heart failure have some form of ______

Answer 7

annular dilatation

Question 8

Regurgitation into the left atrium produces ___ _______.

Answer 8

Regurgitation into the left atrium produces LA dilatation.

Question 9

with acute mitral regurgitation the normal compliance of the left atrium does not allow much _______ and the left atrial pressure ____

Answer 9

with acute mitral regurgitation the normal compliance of the left atrium does not allow much dilatation and the left atrial pressure rises

Question 10

Pulmonary venous pressure can rise and produce _____ ______

Answer 10

Pulmonary venous pressure can rise and produce pulmonary oedema

Question 11

what are the symptoms?

Answer 11

• breathlessness
• peripheral oedema
• fatigue
• CCF

Question 12

why breathlessness?

Answer 12

pulmonary venous hypertension

Question 13

why peripheral oedema?

Answer 13

patients can develop RHF due to back pressure effects

Question 14

why fatigue?

Answer 14

due to reduced CO

Question 15

what happens to the apex beat?

Answer 15

displaced diffuse - get cardiomegaly

Question 16

what can be felt on examination if MR is severe?

Answer 16

systolic thrill

Question 17

what is the first heart sound like?

Answer 17

soft

Question 18

what kind of murmur may be heard?

Answer 18

pansystolic murmur

Question 19

where does the murmur radiate to ?

Answer 19

the axilla

Question 20

what is the other sound heard?

Answer 20

prominent 3rd heart sound

Question 21

why is there a prominent 3rd heart sound

Answer 21

owing to the sudden rush of blood back to the dilated left ventricle in early-mid diastole

Question 22

what is the most common cause of MR?

Answer 22

functional with HF

Question 23

what is the treatment for MR in HF?

Answer 23

treat the HF aggressively

Question 24

what medication may be given?

Answer 24

diuretics and ACEi (HF)

Question 25

what surgical treatment options are there?

Answer 25

repair

replacement

Question 26

when is repair done?

Answer 26

if there is not much calcification

Question 27

which group do not get surgery ?

Answer 27

people with heart failure

Question 28

what can be done percutaneously ?

Answer 28

clips in infancy

Question 29

what is a prolapsing mitral valve called?

Answer 29

barlow’s syndrome or floppy mitral valve

Question 30

why is the valve floppy ?

Answer 30

• excessively large mitral valve leaflets,
• an enlarged mitral annulus,
• abnormally long chordae or
• disordered papillary muscle contraction.

Question 31

what are the causes of barlow’s ?

Answer 31

• marfans,
• thyrotoxicosis,
• rheumatic or
• ischaemic heart disease
• also occurs with ASD and as part of HCm

Question 32

what are the symptoms of barlow’s ?

Answer 32

• atypical chest pain - sub mammar. Sometimes it is substantial, aching and severe
• palpitations - may occur

Question 33

what are the signs of barlow’s ?

Answer 33

mid-systolic click

Question 34

why is there a mid systolic click in barlow’s

Answer 34

produced by the sudden prolapse of the valve and the tensing of the chordae tendinae that occurs during systole

Question 35

what is the treatment for barlow’s

Answer 35

beta -blockade is effective for the chest pain and palpitations